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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610131
Report Date: 01/21/2025
Date Signed: 01/21/2025 04:20:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250114090357
FACILITY NAME:REM CALIFORNIA LLC - DESERT HILLSFACILITY NUMBER:
197610131
ADMINISTRATOR:IBRAHIM, MOSHOODFACILITY TYPE:
735
ADDRESS:8241 WEST AVENUE C-14TELEPHONE:
(818) 415-4301
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
01/21/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Perpetua Asombang (Program Director)TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff drinking alcohol while at the facility.
INVESTIGATION FINDINGS:
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On 01/21/2025 at 10:00 a.m., Licensing Program Analyst (LPA) Evelin Rios arrived to the facility. LPA was granted entry by one of the three (3) staff present. LPA met with the Program Director, Perpetua Asombang and LPA explained the reason for the visit. An entrance interview was conducted. Three clients were present upon LPA's arrival and one (1) was out in the community.

At approximately 10:40 a.m., LPA conducted a physical plant tour of the facility. LPA did not observe any health or safety issues. While conducting the tour LPA attempted to interview resident #1(R1). R1 did not respond to questioning. LPA processed to interview the other two (2) clients but one (1) of the two (2) refused to be interviewed. At approximately 11:00 a.m., LPA requested copies of the staff schedule, staff contact list and client roster. At approximately 11:30 a.m. LPA interviewed the fourth client when they arrived to the facility. On todays visit LPA interviewed a total of eight (8) Direct Support Professional (DSP) staff. LPA interviewed five (5) staff from 11:43 a.m. to 12:38 p.m. (Continue to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250114090357
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: REM CALIFORNIA LLC - DESERT HILLS
FACILITY NUMBER: 197610131
VISIT DATE: 01/21/2025
NARRATIVE
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(Continued from LIC9099) At approximately 1:30 p.m. LPA attempted to interview three (3) more staff via telephone and only one (1) answered. At approximately 3:00 p.m. LPA interviewed two (2) more staff.
Allegation: Staff drinking alcohol while at the facility. It was alleged that staff #1 (S1) was drinking in the facility while on shift. During LPA's interviews with two (2) out of four (4) clients, the allegation was not corroborated. Both clients indicated they had not witnessed any staff drinking alcohol or smelled alcohol on a any staff members breath. During LPA's interview with the PD, they indicated they had not witnessed alcohol in the facility or staff drinking alcohol. PD also informed LPA a Sheriff also conducted a walk-through of the facility and did not observe and issues. LPA's interview with S1, S1 denied the allegation. During LPA's staff interviews one (1) out of eight (8) staff recalls smelling alcohol on S1's breath. Eight (8) out of eight (8) staff deny witnessing any staff drinking alcohol at the facility. Based on interviews conducted the allegation is deemed Unsubstantiated at this time.


Exit interview conducted a copy of this report signed and delivered.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2